Category Archives: A as in Anaphylaxis

Before I am talking about the two main issues in the UK with the AAI, I am listing the key facts about the 3 different AAI (Adrenaline Auto Injectors) available in the UK, EpiPen (R), JEXT and the Emerade. The latter is the latest addition to the market and comes in 3 doses and 2 needle sizes, which is unique.

Technique: Push firmly against the outer portion of the thigh. When you push Jext firmly against your thigh, a spring activated plunger will be released, which pushes the hidden needle through the seal at the end of the black needle shield, into the thigh muscle and injects a dose of adrenaline. Leave in for 10sec, rub in for 10sec.

Storage: Although Jext does not need any special storage instructions, it should be handled with care ensuring that it does not freeze.

Please keep in mind when receiving a prescription of any of the AAI, ensure you and everyone else taking care of the patient (including nursery staff, school staff, friends, family members) is properly trained on the device. Especially, when the prescription was changed to a different brand.

Unfortunately, there is no mention of the Emerade, which is the latest addition to the UK market. Their manufacturer is currently trying to satisfy rising demand by increasing their capacities as soon as possible.

The reason for the shortage of the AAI in the UK may be due to the fact that EpiPen has been increasingly demanded since Jext had issues with their AAI end of last year/beginning of this year.

From the Notice of Action, it seems the Regulators will be taking investigation into the needle sizes. In other words: Do AAI on the UK market fulfill the requirement of safe and efficient administration (true i.m. injection of the right amount) of adrenaline into the patient’s muscle? I am sure we will be hearing much more about the needle size issue.

What are your thoughts? Do these issues bother you? Would like to hear about your concerns.

Disclaimer:

The information provided is given in good faith. Every effort has been taken to ensure accuracy. All patients are different, and specific cases need specific advise. There is no substitute for good medical advice provided by an allergy specialist.

Last week, we had the opportunity to take part in the SNIFFLE study, a multicentre study researching the now in the UK available flu vaccine. It has been used in the US for years and no severe allergic reactions to its content (among other ingredients, it contains egg) have been observed. The aim of the study here in the UK is to proof the safety of the vaccine for egg allergic children. The new thing about the vaccine is that it is given via the nostrils. No more needles, no more tears? We were especially looking forward to a needle free day at hospital (since it is a research project, vaccines are administered under supervision with easy access to emergency treatment).

So we happily decided to take part with our now 3 year old allergyBabe. We were welcomed with a friendly #hellomynameis, allergyBabe went straight for the train track and mum was seated in a comfy armchair. So far, so good.

After the usual observations (blood pressure, oxygen level, pulse, temperature) we were informed, consented and told that there would be a couple of skin prick tests prior to the administration of the vaccine. SKIN PRICK TEST. That means needles. So despite the fact that the vaccine is given as a spray, we still had to undergo the nasty procedure of skin pricking. Despite allergyBabe’s earlier statement not to want any needles, he was very brave and underwent the to him so familiar procedure without a big fuss. The test confirmed his egg allergy.

The vaccination itself was a walk in the park. 1 puff in each nostril, followed by one sneeze, and it was over. To make sure no delayed reaction would occur, we stayed for an hour afterwards, happily engaged in the play area. AllergyBabe showed no adverse effects whatsoever.

Around the third day, he complained about joint paint in his knees, which were gone after one dose of paracetamol. He also developed a slight head cold. Nothing else.

It was a very pleasant experience, from the initial call prior to our appointment to the courtesy call 3 days after the vaccination.

Thinking of taking part? You may think about the following:

If the aim of this study (to proof that the egg containing nasal vaccine is safe for egg allergic children) is achieved,

– egg allergic children will be able to be vaccinated with an easy and painless procedure

– GPs in Primary Care will be confident to administer the vaccine to egg allergic children

– parents will have proof that this vaccine is safe

It the above mentioned points can be achieved, it was worth the inconvenience of traveling to hospital, staying there and getting pricked.

After all, every vaccination that is performed is not only protecting the individual, but also the community in which they live and thrive.

Every 10th of the month, we will take the opportunity to refresh the basics in case of an emerging anaphylactic reaction.

So we got out our emergency kit, checked all bottles and pens, their expiry dates and contents. And, every family member had a go at demonstrating the others how they would administer the Epipen. All did a really good job:

“Blue to the Sky, orange to the thigh”: reminds you what part is the top and what is the bottom (containing needle):

Take off the blue cap, form a fist around the pen, and apply the orange end which contains the needle firmly in the outer part of the upper thigh:

Hold the pen tightly for 10 sec (one elefant, two elefants…, 10 elefants), remove the pen and rub the thigh.

If the patient is lying down, do not move him.

Call 999 and wait for the ambulance. If no improvement within 5-7 min, apply another epipen to the other thigh.

THE Hepi DAY:
Every 10th of the month, we will take out our trainer pen and practice, practice, practice! Plus, take the opportunity to look through your emergency kit for out of date products.
Let’s get this Epipen Training going! Studies show you have to constantly practice to be prepared and able to use your adrenaline pen correctly! Why the tenth? To remind us to leave the needle in for 10 seconds…Stay hepi

Maybe the most raised question in the allergy community: when is the right time to apply the epipen? No doubt it is the only drug able to break the vicious cycle, and its benefits outweight the risks. But actually when is the right time for it?

Even experts discuss the issue widely and have not come up with a formal consent. Based on experience, literature and recent incidents, this is one of the most sufficient answers I have encountered yet. So please take five minutes of your precious time and read this excellent advice by M.D. Phil Lieberman.

I have been sitting over this post for quite a while now. Doing some proper thinking and finding the right arguments takes some time, and after completing the post, reality once more caught up with me, and had forced me to gradually adapt my wording, my thinking and my opinion.

This was supposed to be about how to deal with food allergies in a calm and rationale manner. It turned out to be quite different, as you may notice when reading further on. I was all convinced how stupid it is to get hysterical about foods allergybabe is allergic to, but, I admit, I adjusted my point of view. It is now a more complex approach I laid out and if you agree, I am happy. If not, I would love to hear about your views.

As a mum of an allergic child who had 6 anaphylactic reactions by the time he was 7 month old, not knowing what had caused his extreme reactions, I consider myself to completely understand the emotions and thoughts that constantly run in a parent’s head when taking care of an allergic child.

To any of you reading this from an outsider’s perspective (a friend of a friend with allergies, a care nursery teacher, a parent of a friend of an allergic child etc.) just let me try to explain why we are the way we are. Why we are so apprehensive about foods our children are allergic to, especially with peanuts.

The rationale behind the emotions involved in food allergy or: why we are entitled to occasionally freak out…

Anyone witnessing a proper anaphylactic reaction of his child will by any means avoid it to happen again. It is a very daunting and frightening experience.

Peanuts are one of the eight most common food allergens and are one of the foods that cause anaphylaxis, the most severe form of allergic reaction, which can lead to the individual’s death. And it does not matter how rare this event may be, if it could be your child.

Peanuts can hide every where, small amounts, invisible to the eye, can stick to a door handle, a toy at nursery, a food tray, a table cloth, a takeaway and can hide within an innocent looking biscuit. Tiny amounts can harm, and it is a natural reaction to be extra cautious about it.

Media and charity groups are covering the issue extensively, constantly reminding how lethal a tiny amount can be.

Twitter and other social media tools easily amplify and distribute an individual’s biased opinion.

As it is difficult to predict the likely severity of food-induced allergic reactions, parents and sufferers are on constant alert mode to avoid the allergen.

Statistics help to judge the likelihood of a reaction within a wider population, though they cannot predict an individual’s risk profile.

Is it in any way helpful to get hysterical over a legume?

Impartiality is the widely accepted approach to any medical issue.If doctors would panic, we would not get the appropriate care. That is why there are doctors, nurses and other professional medical staff. It is not the parent who has to act as a medical professional. But what to do if the parent happens to be a trained doctor? Who has had several encounters with life threatening situations, who quite routinely ran to a CPR when the telephone rang in that all to familiar high pitched sound, listening to a computer animated voice which told you where in the hospital the patient is about to depend on your skills and professionalism to get back to life? Doctors are trained to stay calm, not to emotionally get involved, to forecast what could happen next and decide how to proceed. As a professionally trained parent, you try to stay calm and still provide the emotional support for your child without overseeing best medical care.

Others may say as long as you do the right thing, nothing seriously can happen. And I believed it, too. And than, a young girl dies in a camp in California. A young child who knew about her allergies, who did not take changes, who was very aware of the dangers.

Once I read a mother’s comparison of her child’s food allergies: Imagine a chef would prepare your meal, and just before doing so, he filled a rat trap with poison. He did not wash his hands afterwards, he used the same equipment, he used the very same plates etc. You would be horrified because there would be that real danger of getting severely poisoned. See the picture. That is how we, the parents, see food allergies. We are on high alert. Always. Every single day. Because you just know, that one day, out of the blue, your child will have a reaction.

We all agree now that we have to avoid all contact with allergens. Do we have to avoid it by all means? I strongly believe in an individual’s right of freedom. Do not do anything for your own sake that involves restricting anyone else’s freedom. That is part of Germany’s Grundgesetz (German Constitution) and I am a strong believer in its profound value. How can it be applied to protecting food allergy sufferers? Where does individual safety and freedom end? Is society to be restricted for the sake of an individual’s health? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Where do we stop to demand and support from society? Is it ok to ban peanuts and other nuts from school halls and nurseries? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Do food allergic people have a right to ask for peanut free buffer zones on a plane? The questions do not stop here.

Can we allow grocery stores to sell peanuts? Is it ok to deny a child to feed the squirrels a handful of peanuts on the playground? Can we accept that other children will have a snack while playing on a common ground? Can a fellow tube rider have a guilt free snicker?

If you expect an answer, you are mistaken. I do not have an answer. But if you have ever witnessed a life threatening reaction, you will do anything to avoid it a second time.

You will do anything not to risk your child’s life ever again. Full stop.

I guess in the future, society will have to decide how high on a pedestal they put the individual’s needs and how much we are willing to limit freedom of the majority.

*This post was inspired by all the brave parents who care restlessly for their food allergic children and the following two articles:

Air Canada: I just learned about an official decision (and final decision) by the Canadian Transportation Agency (CTA) from June 16th, 2011. Here are the essentials:

– Air Canada is to create a buffer zone for seriously peanut allergic passengers. You can request your seat here.

– only peanut free and nut free foods are to be served within the buffer zone.

– a briefing will be given by Air Canada personnel to passengers within the buffer zone that they can only eat foods that are peanut-free and nut-free and that they will only be offered peanut-free and nut-free foods as part of Air Canada’s onboard snack or meal service. In addition, Air Canada personnel is to address situations where a passenger refuses to comply with this requirement by moving the non-obliging passenger or, if necessary due to that passenger’s refusal to move, moving the person with the disability due to their allergy to peanuts or nuts to a seat where the buffer zone can be established.

Delta Airlines: let them know about your peanut allergy and they will create a buffer zone three rows in front and behind. No peanut snacks in buffer zone. Additional non peanut snacks for buffer zone. Pre-boarding to wipe down seats possible.

British Airways: “crew are unable to make on board announcements or alert other customers to individual medical conditions. ” Crew are Epipen trained, but expect travel companions to administer epipen. “In-flight meals do not contain peanuts or peanut products. However, we cannot guarantee meals and snacks are completely peanut free as they may be produced at a facility that handles peanuts”, and “are therefore unable to offer a peanut-free special meal.”

American Airlines: do not serve peanuts, but cannot guarantee peanut free meals. In First, they rost nuts during the flight!

Virgin Atlantic: Peanuts are never knowingly included in any Virgin Atlantic aircraft meals or snacks. However, our meals are not produced in a nut-free environment so may contain traces of nuts. And we can’t stop other passengers from bringing (or eating) their own food onboard, which may include peanuts. Nuts other than peanuts may be served on all Virgin Atlantic flights as part of the menu ingredients and/or the snack service, in all cabins. Any specific and essential dietary requirements need to be ordered through VAA’s Special Assistance department (T: 0844 412 4455)

Japan Airlines: Advance notice (14d minimum)and the airline crew will take measures, such as removal of peanut products from snack and in-flight meals. JAL do not use peanut products inside aircraft snacks for international flights, but other types of nuts may be included and served. JAL cannot guarantee that the flight is completely peanut-free.

Singapore Airlines: Do serve nuts and peanuts during flight, but cater for allergy sufferers with a nut and peanut free meal (and mention the possibility of cross contamination!). Orders take 48 hours notice via local airline office. Rated Best Airline in the World 2013